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Improving Quality of Life for People with Rheumatoid Arthritis

Our program's goal is to improve the quality of life for people with rheumatoid arthritis. Through aggressive research efforts, we are trying to:

  • Define the mechanisms that cause the disease
  • Detect rheumatoid arthritis in its earliest stages (even before symptoms occur)
  • Discover medications to alter the disease course
  • Personalize treatments based on scientific identification of markers of disease (precision medicine).

We anticipate that these efforts will lead to new discoveries and therapies that will continue to enhance patient care.

Recent years have brought important developments in treatments for this condition. By making an early diagnosis and managing medications effectively, it is our goal to put people with rheumatoid arthritis into remission. Our approach is to combine medications with non-pharmacologic management (exercise, healthy diet, physical and occupational therapy) to provide comprehensive care for each person.

What to Expect

Our clinical care program is headquartered in the Yawkey Building on the main Mass General campus. All of our services are also available at Mass General Brigham Healthcare Center (Waltham) and may be available at our community health centers.

At your first appointment, one of our rheumatology providers will review your history, perform a physical examination and determine the appropriate tests to confirm your diagnosis and establish a treatment plan. In its early stages, rheumatoid arthritis may be difficult to diagnose because symptoms may vary, physical examination findings may be very subtle, and people may not have abnormalities on X-rays or in blood tests. Our rheumatology providers’ experience with this disease helps them distinguish rheumatoid arthritis from other conditions, making an early diagnosis and starting your treatment plan.

A Personalized Treatment Plan

Your rheumatology provider will consider many factors when developing your personalized treatment plan such as your age, overall health and medical history, other diseases, your medications and the activity of your disease. The earlier we can diagnose and start treating rheumatoid arthritis, the more we can prevent and/or reduce joint damage, and improve your daily function and enjoyment of life.

Most patients with rheumatoid arthritis benefit from use of medications such as:

  • Nonsteroidal anti-inflammatory medications (e.g. topical diclofenac ointment and oral medications such as ibuprofen, naproxen)
  • Steroids, also called corticosteroids or glucocorticoids (e.g. prednisone, methylprednisolone)
  • Disease-modifying anti-rheumatic drugs (DMARDs)
    • Oral (also called conventional synthetic) medications (methotrexate, hydroxychloroquine, sulfasalazine, leflunomide)
  • Biologic medications—these are medications targeting specific mediators involved in your immune system and the active inflammatory cascade of rheumatoid arthritis including medications that inhibit tumor necrosis factor (TNF), T cell costimulation (abatacept), interleukin 6 (tocilizumab), B cell populations and activation (rituximab).
  • Targeted synthetic medications (JAK inhibitors such as tofacitinib, baricitinib, upadacitinib)

Our rheumatology providers and our entire staff are highly knowledgeable and skilled at optimizing your treatment approach to provide comprehensive care of your rheumatoid arthritis. It is important that you learn about your disease and you are at the center of all decision making.

In addition to determining a medication plan for you, we provide access to other services at Mass General to address problems that may go along with rheumatoid arthritis (e.g. involvement in other systems, functional performance, depression or, in advanced cases, joint damage). These services include:

Most of our patients receive lifelong care at Mass General. We may see you as often as every few weeks if you have acute difficulties, or as infrequently as once a year, if you are in remission. However, if you do not live in the area, we are pleased to comanage care with your local providers.

About This Program

Treating All Disease Stages of Rheumatoid Arthritis

Rheumatoid arthritis is the most common form of autoimmune inflammatory arthritis. Patients experience pain, swelling and stiffness in the joints. The joints most commonly affected are the small joints in the hands and feet. The wrists, ankles and knees can also be affected. Since rheumatoid arthritis is a systemic disease, people with this condition can develop involvement of other organs from the inflammatory process including the lungs, blood vessels (vasculitis), eyes. The cause of rheumatoid arthritis is uncertain. It likely relates to a genetic predisposition in combination with triggers from the environment. Tobacco use is associated with an increased risk for people to develop rheumatoid arthritis. People with rheumatoid arthritis are also at increased risk for other conditions such as heart disease and osteoporosis (thinning of the bones, fractures).

In addition to expert diagnosis, our program offers the latest treatments for all stages of this condition. We have providers who are expert at using musculoskeletal ultrasound to aid in diagnosis as well as in therapeutic interventions with joint and soft tissue steroid injections. Medical advancements continue to improve the outlook for patients with rheumatoid arthritis, and it remains a priority to initiate treatment at an early stage. It is our goal to enable people to experience functional improvement with minimal or no limitations to their daily activities.

In people with more advanced stages of rheumatoid arthritis, we may coordinate your care with Mass General specialists in physical and occupational therapy, mind-body medicine and orthopaedic surgery. Regardless of disease duration, our goal is to help patients reengage fully in their lives with minimal limitations.

Building on a Long Legacy

Mass General has an impressive legacy of research in rheumatoid arthritis. In the 1930s, Walter Bauer, MD, established the Rheumatology Program to bring basic scientists and clinicians together to study and treat this disease. In the 1990s and 2000s, investigator Brian Seed, PhD, was at the forefront of research that led to the development of tumor necrosis factor (TNF) inhibitors, a new class of drugs for rheumatoid arthritis.

Today, Allen Steere, MD, who laid the foundation for understanding Lyme arthritis (a tick-borne spirochetal infection) is using these insights in an effort to uncover causes of rheumatoid arthritis. His laboratory performs translational studies using samples from patients with rheumatoid arthritis to:

  • Identify autoantigens that lead to the immune response that causes this condition
  • Identify biomarkers (biological features) that will help us determine disease stage and a personalized approach to medication selection
  • Optimize diagnostic testing

Several other researchers in our Division, including Marcy Bolster, MD, and Sheila Arvikar, MD are performing clinical research looking at the impact of treatment on vascular inflammation, the use of decision aids to help patients choose the right therapy, and clinical trials looking at new medications to treat rheumatoid arthritis.

Additionally, Andrew Luster, MD, PhD is studying the molecular events that lead to immune cell entry into the joint and resultant joint destruction in people with rheumatoid arthritis. The identification of these mediators may reveal new therapeutic targets for this condition.

Our rheumatology team works to provide our patients with state-of-the-art treatment for this disease. Our providers are known for their ability to tailor their recommendations to the needs of the patient, taking into consideration personal preferences and family concerns. In addition, our clinicians' research enhances the understanding of this condition and our ability to treat it effectively.

Educational Resources

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